# Plain Language Summary: Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021

This bill requires Medicare prescription drug plans to include cheaper generic drugs and biosimilar medications on their approved drug lists, starting in 2022. Right now, insurance companies can choose which drugs to cover, and they sometimes leave off lower-cost options. This bill says if a generic drug or biosimilar costs less than the brand-name version it's based on, the insurance plan must include it. It also prevents insurance companies from making it harder to get these cheaper drugs through tactics like requiring special approval first or making you try other drugs before you can use them.

The bill also creates special pricing tiers to encourage seniors to actually use these cheaper options. Insurance plans must have at least one tier that only includes generic and biosimilar drugs, with significantly lower out-of-pocket costs than the cheapest brand-name drug tier. For expensive specialty drugs, plans must create another tier for cheaper generic and biosimilar alternatives with meaningfully lower costs than the specialty brand-name tier. This means seniors would pay less when they choose the generic or biosimilar option, giving them a real financial incentive to use them instead of pricier brand names.

The practical effect is that seniors on Medicare should have easier access to affordable medications and lower prescription costs. Instead of being steered toward expensive brand-name drugs, they'll have clear, cheaper alternatives readily available with lower copays. This could save seniors hundreds of dollars annually on medications while still ensuring they have access to the drugs they need.

Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021

McKinley, David B.

Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 This bill establishes additional requirements for prescription drug plan (PDP) sponsors that use formularies under the Medicare prescription drug benefit. Specifically, the bill requires PDP formularies to include covered generic drugs and biosimilars for which the wholesale acquisition cost is less than that of the reference (i.e., brand-name) product. PDP sponsors must also establish specific cost-sharing tiers that apply lower cost-sharing requirements for such covered generic drugs and biosimilars as compared to those for brand-name products. The bill also prohibits PDP sponsors from instituting certain requirements relating to access to such covered generic drugs and biosimilars that are more restrictive than those for brand-name products (e.g., prior authorization requirements).